Survival rates improve among patients with HIV, MDR-TB coinfection

Treatment outcomes and survival have improved in recent years for South African patients with multidrug-resistant TB and HIV, with outcomes nearing those of patients infected only with MDR-TB, study data showed.

James Brust

“MDR-TB carries high mortality rates, especially in patients coinfected with HIV. Many of the studies showing poor outcomes, however, were conducted prior to the availability of ART,” James C.M. Brust, MD, associate professor of medicine at Montefiore Medical Center, New York, told Infectious Disease News. “Until recently, it was unknown how best to manage MDR-TB/HIV coinfection, and clinicians had concerns about treating both diseases concurrently — particularly related to pill burden and side effects.”

Brust and colleagues conducted an observational cohort study of 206 patients in South Africa with culture-confirmed MDR-TB, 150 of whom also had HIV. All patients were enrolled between 2011 and 2013, and all underwent standardized treatment regimens for both HIV and MDR-TB. The researchers followed patients monthly to evaluate adherence, adverse events and treatment response.

Most patients were female (n = 131; 64%), and the patients’ median age was 33 years. One hundred ninety-one patients had a final outcome for MDR-TB during the study; of these 73% (n = 130) were either cured or successfully completed treatment, Brust and colleagues reported. These outcomes did not differ by HIV status (P = .5).

Among patients with HIV, the median CD4 count after 2 years was 386 cells/mm³, rising by 140 cells/mm³ from baseline (P = .005). More than half of patients (64%) had an undetectable viral load, the researchers wrote.

Patients with HIV and MDR-TB demonstrated an 86% survival rate, compared with 94% in patients who did not have HIV (P = .34), Brust and colleagues reported. A CD4 count of 100 cells/mm³ or less was the strongest risk factor for mortality, the researchers wrote (adjusted HR = 15.6; 95% CI, 4.4-55.6).

“Our findings have important implications for clinical practice and guideline development,” Brust said. “First, it’s clear that all patients with MDR-TB and HIV coinfection should be treated with ART. Secondly, they must be followed and monitored closely and provided with patient-centered care to ensure high levels of treatment adherence, consistent virologic suppression and immunological recovery. This will ensure the highest likelihood of survival, treatment success, and cure of their MDR-TB.” – by Andy Polhamus

Disclosures: The authors report no relevant financial disclosures.

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Source:

Brust JCM, et al. Clin Infect Dis. 2017;doi:10.1093/cid/cix1125.